WEBVTT - Ep 134 Tonsils: Underestimated and underappreciated 0:00:00.080 --> 0:00:04.320 Hello. My name is Aaron, and I'm here too talk 0:00:04.360 --> 0:00:09.319 about my tonsalectomy experience. So this happened when I was 0:00:10.000 --> 0:00:13.320 thirty five years old. It started, I guess in my 0:00:13.400 --> 0:00:18.680 early thirties. I was getting pretty consistently, I would say, 0:00:18.680 --> 0:00:21.320 two to three times a year some sort of tonsil 0:00:21.400 --> 0:00:24.040 infection where I would have to be on a two 0:00:24.160 --> 0:00:26.480 or three week course of antibiotics to clear it up. 0:00:27.000 --> 0:00:29.960 And this was really doing a number on well, my 0:00:30.000 --> 0:00:33.080 gut health for one, and just my health in general. 0:00:33.720 --> 0:00:36.960 This was kind of taking place right after COVID had started, 0:00:37.479 --> 0:00:40.440 and with these infections came a lot of fevers and 0:00:40.520 --> 0:00:44.479 just being run down and ill, which kind of resulted 0:00:44.479 --> 0:00:46.160 in me missing a lot of work because we weren't 0:00:46.159 --> 0:00:48.120 one hundred percent sure if it was COVID or not. 0:00:49.159 --> 0:00:52.120 It never was, but I just had to keep going 0:00:52.159 --> 0:00:56.680 in for these infections over and over, and finally my 0:00:56.760 --> 0:01:01.880 doctor said, this is too many antibiotics. Have you considered 0:01:01.880 --> 0:01:05.120 having your tonsils take it out? Because this is probably 0:01:05.160 --> 0:01:09.119 just going to keep happening. And I thought about it 0:01:09.280 --> 0:01:13.160 and my coworker, her son, who I don't remember how 0:01:13.200 --> 0:01:15.640 old he was, maybe eight or nine, had just had 0:01:15.680 --> 0:01:19.959 his tonsils out and he was fine. Two days later 0:01:20.000 --> 0:01:23.200 he was back at school. So I thought, well, this 0:01:23.240 --> 0:01:26.440 can't be that bad. Kids do it all the time. 0:01:27.200 --> 0:01:30.920 And I asked my doctor, you know, how long would 0:01:30.920 --> 0:01:32.920 I be out of work, and he said probably two 0:01:33.000 --> 0:01:34.760 to three days. So I put in for two to 0:01:34.800 --> 0:01:39.920 three days and scheduled the procedure. So I went in. 0:01:40.400 --> 0:01:44.559 Everything I guess went really well. My husband was there 0:01:45.080 --> 0:01:48.400 when I woke up. I don't really remember this, but 0:01:48.480 --> 0:01:51.559 I guess when I woke up, I was trying to yell, 0:01:52.240 --> 0:01:55.200 so they actually had to come in and re sedate 0:01:55.320 --> 0:01:58.040 me because I was coughing so much. So I spent 0:01:58.120 --> 0:02:01.160 an extra few hours in the recover room waking up, 0:02:01.600 --> 0:02:03.640 and the doctor came in, you know, and he told 0:02:03.680 --> 0:02:09.679 my husband everything went fine, gave him the prescriptions and said, unprompted, 0:02:09.840 --> 0:02:12.920 he said she'll be back to eating hard tacos in 0:02:13.200 --> 0:02:16.760 a few days, which was kind of you know. I 0:02:16.800 --> 0:02:20.000 wasn't awake for it, I don't remember. And so we 0:02:20.040 --> 0:02:23.079 went home, and you know, as the medications kind of 0:02:23.120 --> 0:02:25.600 wore off, my husband went and picked up. They gave 0:02:25.639 --> 0:02:29.560 me a codeine elixir, and I vividly remember for the 0:02:29.600 --> 0:02:32.760 next night and the night after that, sitting kind of 0:02:32.800 --> 0:02:36.600 propped up in bed, psyching myself up for half an 0:02:36.600 --> 0:02:42.200 hour to swallow my own spit because it hurt so badly. 0:02:43.440 --> 0:02:46.360 I this is gross. I kind of decided it wasn't 0:02:46.400 --> 0:02:49.040 worth it at some point and just started spitting it out. 0:02:50.520 --> 0:02:52.680 And this, as you can imagine, kind of created a 0:02:52.720 --> 0:02:57.640 problem for one staying hydrated and to actually getting my 0:02:57.760 --> 0:03:01.200 pain medication down. Even though it was a syrup, I 0:03:01.639 --> 0:03:03.960 just even just to swallow a sip of water was 0:03:04.200 --> 0:03:05.240 pretty agonizing. 0:03:06.760 --> 0:03:08.079 So after a couple. 0:03:07.919 --> 0:03:10.560 Of days of this, I was very, very run down, 0:03:11.280 --> 0:03:14.720 and I had started coughing up this awful brown gunk, 0:03:15.919 --> 0:03:19.000 and so I don't remember it was maybe around midnight. 0:03:19.160 --> 0:03:21.320 My husband ended up taking me to the emergency room, 0:03:21.840 --> 0:03:23.920 and I guessed when I got there, they said the 0:03:23.960 --> 0:03:26.360 gunk was to be expected, which I was not warned about, 0:03:27.200 --> 0:03:30.160 but I was also severely dehydrated, so they had to 0:03:30.200 --> 0:03:33.160 give me a couple bags of fluid, and they said 0:03:33.160 --> 0:03:35.480 that codine is not going to cut it, and I 0:03:35.480 --> 0:03:38.840 think they gave me hydrocodone, which was also a problem 0:03:38.880 --> 0:03:42.400 because those are huge pills. So for the next couple 0:03:42.480 --> 0:03:46.000 of weeks I did not go back to work. Because 0:03:46.040 --> 0:03:50.480 I couldn't really drink anything, I couldn't eat anything except jello, 0:03:50.600 --> 0:03:54.000 and eventually putting just a couple of bites every day. 0:03:54.120 --> 0:03:57.240 I was kind of getting by on pedia light. Just 0:03:57.320 --> 0:04:00.720 felt terrible. It was obviously I don't know what this 0:04:00.800 --> 0:04:03.440 feels like, but it kind of felt like swallowing razor blades, 0:04:04.400 --> 0:04:07.520 and so, you know, eventually it did get better, but 0:04:07.600 --> 0:04:10.119 I think when I looked back, even three or four 0:04:10.160 --> 0:04:13.080 months later, I still was pretty sore. 0:04:13.600 --> 0:04:14.320 And all this is. 0:04:14.400 --> 0:04:15.760 You know, I don't want to say don't get a 0:04:15.800 --> 0:04:19.880 tonsil ectomy. If you need one, you definitely should, but 0:04:20.160 --> 0:04:22.279 you know, I wish my doctor had been a lot 0:04:22.360 --> 0:04:26.280 more upfront with me about how terrible it was going 0:04:26.360 --> 0:04:29.960 to be. But on the plus side, I obviously haven't 0:04:30.000 --> 0:04:32.920 had a tonsil infection since because I don't have tonsils anymore. 0:04:33.240 --> 0:04:35.760 And I actually just had my first sore throat since 0:04:35.800 --> 0:04:39.159 the procedure a couple months ago, which is kind of exciting. 0:04:39.880 --> 0:04:42.279 I'm not on antibiotics all the time anymore, which is 0:04:42.400 --> 0:04:46.279 great and one of the things that kind of stuck 0:04:46.320 --> 0:04:48.880 with me. I talked to my grandmother, who had been 0:04:48.880 --> 0:04:52.640 a nurse for decades after I was done with a 0:04:52.680 --> 0:04:56.320 procedure about what had happened, and she said, I didn't 0:04:56.360 --> 0:05:00.279 want to tell you before you had this done. But 0:05:00.320 --> 0:05:02.560 the only thing I've heard it compared to pain wise 0:05:03.200 --> 0:05:05.960 is like an adult circumcision. And I kind of thought, why, 0:05:05.960 --> 0:05:09.760 I wish you had told me that to be better prepared. 0:05:10.040 --> 0:05:13.520 And also I ended up going into nursing afterwards, and 0:05:13.560 --> 0:05:15.440 I would tell nurses, you know, I had this ton 0:05:15.520 --> 0:05:17.880 selectomy in my thirties, and they would just get this 0:05:17.960 --> 0:05:22.200 look like why would you do that? So yeah, all 0:05:22.240 --> 0:05:24.520 that to say is I wish they had been more 0:05:24.600 --> 0:05:27.000 upfront about how terrible it was. But I am also 0:05:27.000 --> 0:06:13.800 glad that I did it. 0:06:14.080 --> 0:06:18.600 Aaron, great name, great name, great story, great story. 0:06:18.720 --> 0:06:20.239 Horrible story, horrible story. 0:06:20.760 --> 0:06:26.560 I had no idea how bad adult tonsle ectomies could be. 0:06:27.120 --> 0:06:33.960 I oo, it sounds just awful, awful, awful. I'm so sorry. 0:06:34.279 --> 0:06:36.360 Yeah, but also thank you for sharing your story. 0:06:36.400 --> 0:06:40.280 Thank you so much. Hi. I'm Aaron Welsh and I'm 0:06:40.360 --> 0:06:41.720 Eron Ollman Updyke. 0:06:41.520 --> 0:06:44.200 And this is this podcast will kill you Today we're 0:06:44.200 --> 0:06:47.600 talking all about tonsils. I mean kind of an off 0:06:47.640 --> 0:06:49.240 the wall topic, a little. 0:06:49.000 --> 0:06:51.280 Bit off the pharyngeal wall of. 0:06:54.160 --> 0:06:57.200 I don't know why it might have been prompted. I 0:06:57.240 --> 0:06:59.960 can't remember if I got a tonsilstone before or after 0:07:00.040 --> 0:07:03.000 or I suggested this. I think it was after, which 0:07:03.040 --> 0:07:04.600 is I conjured it? 0:07:04.920 --> 0:07:10.680 You really did? You suggested tonsils and I was like what, 0:07:11.960 --> 0:07:14.840 And then immediately it was like, yeah, do it. I 0:07:14.840 --> 0:07:17.720 have no idea how this is going to go or 0:07:17.760 --> 0:07:21.560 what we're going to talk about, but like, why not tonsils? 0:07:21.640 --> 0:07:25.600 I mean, I feel like tonsils occupy this weird space 0:07:25.920 --> 0:07:27.840 in like cultural history. 0:07:28.000 --> 0:07:29.400 Oh I thought you were going to say, like in 0:07:29.440 --> 0:07:35.960 your orofarings. Oh, well, that's true. It's gonna be all episode. 0:07:37.280 --> 0:07:40.120 Like I remember as a kid wanting to have my 0:07:40.200 --> 0:07:42.840 tonsils taken out so that I could miss school and 0:07:42.880 --> 0:07:44.520 eat ice cream. Like that's what I thought. 0:07:44.520 --> 0:07:46.640 It was. Oh my god. Okay, So when I told 0:07:46.640 --> 0:07:48.760 my parents that we were going to be doing tonsils, 0:07:49.880 --> 0:07:52.640 it's been hilarious to tell people that were doing this episode. 0:07:52.720 --> 0:07:54.440 My mom was like, oh, I still have mine, but 0:07:54.480 --> 0:07:56.520 a lot of people don't, like a lot of people 0:07:56.600 --> 0:07:58.480 my age. And then she turns to my dad and 0:07:58.520 --> 0:08:00.360 she goes, do you still have your tonsils? And yeah, 0:08:00.360 --> 0:08:02.440 I got mine, but everyone wanted to get theirs out 0:08:02.480 --> 0:08:04.360 and I was like what, and he goes, well, you 0:08:04.400 --> 0:08:08.040 got ice cream? Where did this? 0:08:08.440 --> 0:08:09.840 Where did this? Notion? 0:08:10.440 --> 0:08:10.560 It? 0:08:10.680 --> 0:08:14.560 Like dug in so deeply I distinctly remember. And I 0:08:14.560 --> 0:08:19.000 don't even know if I knew anyone growing up. John 0:08:19.440 --> 0:08:26.240 my fiance has his tonsils gone. And I think also. 0:08:27.400 --> 0:08:31.840 In Madeline, was it her tonsils or her appendix? Her appendix? Yeah, 0:08:32.480 --> 0:08:34.480 so it wasn't that. Then I don't know. 0:08:34.760 --> 0:08:37.720 I mean, actually I do know, because I the history 0:08:37.760 --> 0:08:39.160 section will reveal all. 0:08:39.559 --> 0:08:40.480 Oh okay, I. 0:08:40.440 --> 0:08:45.960 Can't wait, which doesn't usually happen. And maybe it doesn't 0:08:45.960 --> 0:08:49.160 reveal all, but I do feel like it answered a 0:08:49.160 --> 0:08:52.640 lot of my own personal questions about like why were 0:08:52.640 --> 0:08:55.760 ton selectamies, why do we know them by name? Why 0:08:55.760 --> 0:08:58.720 didn't everyone seem to have a tons electomy? And like 0:08:59.600 --> 0:09:01.280 most of the twentieth century. 0:09:01.040 --> 0:09:03.920 Ooh, I can't wait to hear all about it. But first, 0:09:04.240 --> 0:09:06.280 but first, it's quarantiny time. 0:09:06.760 --> 0:09:10.880 It certainly is, Thank goodness, what are we drinking this week? 0:09:11.000 --> 0:09:15.559 In the spirit of Ton selectamees, we're drinking the Cutthroat. 0:09:14.880 --> 0:09:19.160 Not just a trout, but also a delicious cocktail recipe. 0:09:19.679 --> 0:09:22.160 What is what is in the Cutthroat. 0:09:22.480 --> 0:09:28.280 It is a malted chocolate milk beverage that'll make sense later, 0:09:28.360 --> 0:09:33.760 I promise, with malted milk powder and vanilla ice cream, 0:09:34.120 --> 0:09:38.840 chocolate sauce, some whiskey in there. Oh, it's just fantastic. 0:09:38.520 --> 0:09:41.679 Honestly, so perfect. Had to have the ice cream in 0:09:41.720 --> 0:09:45.960 there too, like of course. But we will post the 0:09:46.080 --> 0:09:50.679 full recipe for the Cutthroat, Quarantiney and the non alcoholic 0:09:50.720 --> 0:09:53.160 place Rita on our website. This podcast will kill You 0:09:53.200 --> 0:09:56.080 dot com and all of our social media channels. 0:09:56.520 --> 0:09:59.360 Our website, This podcast will kill you dot Com. It's 0:09:59.360 --> 0:10:01.360 a pretty incredib website if you haven't been there yet 0:10:01.360 --> 0:10:03.680 and check it out. We've got transcripts from all of 0:10:03.679 --> 0:10:06.360 our episodes. We've got sources from this episode and every 0:10:06.360 --> 0:10:08.600 one of our episodes. We've got links to blood Mobile 0:10:08.960 --> 0:10:14.240 for music. We've got our good Reads account, our oh 0:10:14.280 --> 0:10:16.960 I'm flailing here, We've got Patreon, We've got us there's 0:10:17.640 --> 0:10:18.079 check it out. 0:10:18.200 --> 0:10:21.480 You're good, You're good, We got it merge. 0:10:21.600 --> 0:10:26.120 Okay, are we ready for the biology? 0:10:26.440 --> 0:10:27.760 Let's do it right after this break? 0:10:27.880 --> 0:11:00.720 Okay, Tonsils, Tonsils, And now I that I had written 0:11:00.760 --> 0:11:03.800 something really clever to start this off with. But I didn't. 0:11:04.160 --> 0:11:07.559 I mean, tonsils don't rhyme with like anything. I know 0:11:07.800 --> 0:11:10.120 you sent me that screenshot of all the things they 0:11:10.400 --> 0:11:11.680 ninety two percent rhyme with. 0:11:12.080 --> 0:11:15.280 Right, It's terrible. Console was the closest. 0:11:15.400 --> 0:11:19.600 It's not even good. So first of all, what most 0:11:20.000 --> 0:11:24.040 of us think of when we think of our tonsils 0:11:24.559 --> 0:11:30.160 are in fact only one of four different tonsils in 0:11:30.200 --> 0:11:31.000 our bods. 0:11:31.280 --> 0:11:33.680 Yeah, that was like one of the first things I learned, 0:11:33.679 --> 0:11:35.640 and I was felt like I had been lied to 0:11:35.720 --> 0:11:39.880 my whole life, But really I just didn't seek the knowledge. 0:11:41.000 --> 0:11:44.080 So the set of two tonsils, it's a paired set 0:11:44.120 --> 0:11:47.240 of tonsils that sit at the back of our throat, 0:11:47.320 --> 0:11:50.680 the ones that get swollen when we get strep throat 0:11:50.920 --> 0:11:56.079 or any other infection. Those are called our palatine tonsils. 0:11:56.520 --> 0:11:59.520 But we have three more. We have tonsils at the 0:11:59.600 --> 0:12:03.280 very base of our tongue, like where our tongue connects 0:12:03.480 --> 0:12:07.520 back in the base that are appropriately named our lingual tonsils. 0:12:08.480 --> 0:12:10.640 We have a set that's like in the wall of 0:12:10.640 --> 0:12:14.080 our naso pharynx, way back up near the opening to 0:12:14.160 --> 0:12:18.640 our eustachian tubes. That's our ear tubes. And those are 0:12:18.679 --> 0:12:23.120 called our tubal tonsils. They're little. And then we have 0:12:23.240 --> 0:12:28.920 another one that sits at the top rear of our palette, 0:12:28.960 --> 0:12:32.640 in our naso pharynx like above and behind our soft palate, 0:12:32.960 --> 0:12:36.440 right in the midline where our nose kind of connects 0:12:36.440 --> 0:12:39.360 to the back of our throat. And this particular tonsole, 0:12:39.440 --> 0:12:44.240 which is called our phyngeal tonsil, is also called our adenoid. 0:12:44.679 --> 0:12:46.040 Ah okay, so. 0:12:46.000 --> 0:12:50.319 When you hear adenoids and tonsiles, those are the same things. 0:12:50.360 --> 0:12:53.960 They're just talking about two different sets of tonsoles. And 0:12:54.120 --> 0:12:57.240 everyone always says adenoids, but it's just one, like it's 0:12:57.280 --> 0:13:01.040 one structure. It's not a paired it's a one. 0:13:01.400 --> 0:13:05.679 I mean, it's like JC Pennies or Myers. 0:13:04.920 --> 0:13:07.400 Or sorry you say J C. Pennies plural. 0:13:08.000 --> 0:13:10.720 I have heard people say that. I do say Myers. 0:13:11.080 --> 0:13:11.920 What is Myers? 0:13:12.120 --> 0:13:13.880 Remember Meyer the grocery store chain? 0:13:14.000 --> 0:13:16.800 Oh yeah, yeah, yeah, yeah, I forgot about that, yeah, 0:13:17.040 --> 0:13:25.400 showing our Midwest. Yeah. Anyways, anyways, our adenoids and our tonsils, 0:13:26.280 --> 0:13:30.800 meaning our phyngeal tonsil and our palatine tonsils, are the 0:13:31.040 --> 0:13:34.720 two that we all think of the most when we 0:13:34.840 --> 0:13:38.520 think of our tonsils, because these are the ones that 0:13:38.640 --> 0:13:42.880 get big and swollen and oftentimes painful when we get 0:13:43.160 --> 0:13:46.800 an infection. So these are the two that we'll focus 0:13:46.840 --> 0:13:49.720 on kind of. But really, when I'm talking about tonsils, 0:13:49.760 --> 0:13:53.319 it means all of these different things. So what are 0:13:53.400 --> 0:13:57.360 these things anyway? Like, what the heck are tonsils and what. 0:13:57.280 --> 0:14:00.000 Do they have in common with one another? 0:14:00.280 --> 0:14:04.760 Well, let me tell you. All of these tonsils are 0:14:04.840 --> 0:14:09.719 a type of tissue that are called mucosal associated lymphoid 0:14:09.960 --> 0:14:12.040 tissue or MALT. 0:14:12.440 --> 0:14:13.400 Oh yeah, okay. 0:14:13.600 --> 0:14:17.880 All of these tonsils together form a ring at the 0:14:17.960 --> 0:14:20.880 back of our throat, which is essentially at the opening 0:14:20.960 --> 0:14:25.440 of both our digestive and our respiratory systems. Right, and 0:14:25.520 --> 0:14:29.800 this ring is sometimes called wall Dyer's ring, probably named 0:14:29.800 --> 0:14:34.560 after a guy, I'm sure. But the function of all 0:14:34.600 --> 0:14:39.000 of these tissues, all of this ring of tonsilar tissue, 0:14:39.120 --> 0:14:45.480 essentially is in short, to protect us against infection. The end, 0:14:45.880 --> 0:14:48.040 our tonsils are part of our immune system. 0:14:48.400 --> 0:14:51.400 But it's like the type of tissue, so that type 0:14:51.400 --> 0:14:54.960 of tissue is like only found in these tonsils. 0:14:55.160 --> 0:14:59.240 Oh, great question. No, tonsils are by no means the 0:14:59.280 --> 0:15:04.280 only form of MALT mucosal associated lymphoid tissue that exist 0:15:04.440 --> 0:15:07.680 In fact, they are a small part of a large 0:15:07.800 --> 0:15:13.320 network of malt throughout our bodies. Basically all of malt 0:15:13.480 --> 0:15:18.120 are these immune related tissues that exist specifically on our 0:15:18.240 --> 0:15:22.560 mucosal surfaces in our guts. We often call this galt 0:15:23.280 --> 0:15:27.920 gut associated lymphoid tissue. So we have gut tonsils, yeah, 0:15:28.200 --> 0:15:32.240 pretty much. They're called Pyre's patches in our guts. We 0:15:32.320 --> 0:15:35.760 also have like isolated lymphoid follicles that just kind of 0:15:35.800 --> 0:15:39.200 scatter throughout our guts and we have wait for it, 0:15:39.680 --> 0:15:47.800 an appendix, also lymphoid tissue. There's also bronchial malt, which 0:15:47.840 --> 0:15:52.640 is sometimes called BLT, although not all humans have this. 0:15:52.840 --> 0:15:55.200 I don't know. It's probably really interesting. I didn't get 0:15:55.240 --> 0:15:59.120 into it. What rodents don't have tonsils, but they do 0:15:59.200 --> 0:16:03.920 have not which is masofyringeal associated lymphoid tissue. 0:16:04.280 --> 0:16:07.160 This is why spoilers. I didn't get into the evolutionary 0:16:07.280 --> 0:16:10.960 history of tonsils. Is because I got really overwhelmed by 0:16:11.480 --> 0:16:16.280 nalt and malt and disseminated malt and like organized or 0:16:16.320 --> 0:16:17.360 something malt. 0:16:17.120 --> 0:16:20.680 And nalt and I was too much. This sounds very cool. 0:16:21.080 --> 0:16:25.480 Yeah, this is over my head and I'm gonna focus 0:16:25.480 --> 0:16:26.240 on other things. 0:16:26.440 --> 0:16:29.240 Well, let me bring it under your head again, because 0:16:29.680 --> 0:16:30.720 is that appropriate? 0:16:30.960 --> 0:16:32.240 Sure? I love it. 0:16:33.760 --> 0:16:36.200 So the question that we want to understand is, like 0:16:36.280 --> 0:16:39.880 these globs of tissue that are associated with our immune system, 0:16:40.040 --> 0:16:42.320 like what does that actually mean? Like what does it 0:16:42.360 --> 0:16:44.920 even mean to be a part of our immune system? 0:16:44.960 --> 0:16:48.960 What are they doing? What are they composed of? If 0:16:48.960 --> 0:16:53.640 we remember, way, way way back to our Vaccines episode 0:16:54.360 --> 0:17:00.600 season two, I know, major throwback. Yeah, In that episode, 0:17:00.640 --> 0:17:04.040 we talked about the very specifics of the ways that 0:17:04.119 --> 0:17:09.199 our immune system responds to antigens, basically responds to the 0:17:09.240 --> 0:17:14.080 stuff viruses, bacteria, dust, proteins, the crud that we're exposed 0:17:14.119 --> 0:17:16.600 to all the time. And I won't make you go 0:17:16.640 --> 0:17:19.080 back and listen to that, but if anyone wants to, 0:17:19.440 --> 0:17:23.280 it's a great episode. But I'll summarize what we talked 0:17:23.280 --> 0:17:28.080 about really briefly so that we can understand tonsils. In 0:17:28.119 --> 0:17:32.240 that episode, I split the immune system into a four 0:17:32.359 --> 0:17:37.439 act play focusing specifically on our adaptive immune system. The 0:17:37.480 --> 0:17:41.760 summary is basically that our bodies, mostly via things like 0:17:41.880 --> 0:17:44.280 our nose and our mouth, but also our guts and 0:17:44.320 --> 0:17:49.480 our skin and our eyes, are constantly exposed to hundreds 0:17:49.520 --> 0:17:53.960 of thousands of stuff every day, and we call this 0:17:54.000 --> 0:17:59.520 stuff antigens, and our immune system's job is to identify 0:17:59.680 --> 0:18:03.640 all of this stuff and decide what belongs and what doesn't, 0:18:03.760 --> 0:18:06.400 what's a part of us, and what is not supposed 0:18:06.400 --> 0:18:08.719 to be there, and how to deal with it. And 0:18:08.800 --> 0:18:11.240 one of the major ways that we do this is 0:18:11.240 --> 0:18:15.640 that we have cells in our body called macrophages. These 0:18:15.680 --> 0:18:19.720 cells go along in either our bloodstream or our lymphatics 0:18:20.600 --> 0:18:24.240 and they gobble up this crud, these antigens wherever they're 0:18:24.280 --> 0:18:27.920 exposed to them and bring them to our T cells, 0:18:28.640 --> 0:18:32.240 who then bring that crud to our lymph nodes, which 0:18:32.280 --> 0:18:34.800 we also touched on in our Lymphatic Philrise this episode, 0:18:35.840 --> 0:18:39.160 and lymph nodes is where our B cells hang out, 0:18:39.680 --> 0:18:44.120 and our B cells are what make antibodies that will 0:18:44.119 --> 0:18:47.120 then be very specific to be able to find, neutralize, 0:18:47.160 --> 0:18:52.600 and destroy the crud the anigens. It turns out that 0:18:52.600 --> 0:18:57.280 that part is accurate, but leaves out part of the 0:18:57.320 --> 0:19:01.160 story of our immune system, and that story is is malt. 0:19:02.240 --> 0:19:05.879 So malt it sounds like you're talking about a person. 0:19:08.000 --> 0:19:10.600 It just makes me think of malted milk. I mean 0:19:11.080 --> 0:19:19.160 appropiate appropriate, Okay, so malt, the composition of malt tissue 0:19:19.720 --> 0:19:24.840 is very similar to our lymph nodes themselves, except that 0:19:25.760 --> 0:19:30.080 it is not connected to our lymphatic system. 0:19:30.359 --> 0:19:33.160 That is so bizarre. 0:19:33.480 --> 0:19:38.240 And mm hmm it gets cooler because the stuff that 0:19:38.640 --> 0:19:42.320 MALT is sampling, the stuff that it's going to decide 0:19:42.400 --> 0:19:45.119 whether or not for our B cells to mount a 0:19:45.200 --> 0:19:51.040 response to, is being sampled directly from the mucosa itself, 0:19:51.480 --> 0:19:54.800 rather than going through macrophages, traveling through the lymphatics and 0:19:54.800 --> 0:19:57.400 then making its way to the lymph nodes. So it's 0:19:57.440 --> 0:20:01.240 like first line exactly. It is first line. That is 0:20:01.280 --> 0:20:03.600 what malt is. It is first line immune system. 0:20:04.600 --> 0:20:06.480 Okay, now I kind of wish I had read more 0:20:06.480 --> 0:20:09.399 about the evlcary history because I wonder how basal that 0:20:09.560 --> 0:20:12.240 is compared to other parts of our immune system. 0:20:12.400 --> 0:20:16.400 Anyway, it would be really interesting. Histologically, malt is very 0:20:16.440 --> 0:20:20.399 similar to lymph nodes, except that it doesn't tend to 0:20:20.440 --> 0:20:24.360 have a capsule, and again they don't have any lymphatic drainage. 0:20:24.880 --> 0:20:28.399 But the outer cells of malt tissue, including our tonsils, 0:20:28.480 --> 0:20:31.800 have these cells called m cells, which are depending on 0:20:31.840 --> 0:20:36.200 the source, called membrane cells or microfold cells. But These 0:20:36.200 --> 0:20:39.840 are cells that are essentially just really good at uptaking 0:20:40.080 --> 0:20:43.640 the stuff that our mucosa, our nose, our mouth, our 0:20:43.680 --> 0:20:49.720 guts are constantly exposed to floating across our mucosa. These 0:20:49.920 --> 0:20:53.800 M cells take them up and then shuttle them into 0:20:53.920 --> 0:20:58.240 the core of these tonsils or other malt tissue, but 0:20:58.320 --> 0:21:02.439 we'll focus on tonsils for this episode. Our tonsils have 0:21:02.600 --> 0:21:07.600 these crypts, these like deep crypts, and so these structures 0:21:07.600 --> 0:21:10.159 are covered with this epithelial tissue, and then these M 0:21:10.240 --> 0:21:15.919 cells just like swoop stuff into the inner bits where 0:21:16.160 --> 0:21:20.359 are housed B cells and T cells. And these B 0:21:20.520 --> 0:21:23.760 and T cells do exactly what they do everywhere else 0:21:23.760 --> 0:21:28.200 in our body. They sample anigens and then they make antibodies. 0:21:29.440 --> 0:21:31.520 And it gets even cooler because I can see your 0:21:31.560 --> 0:21:37.040 face being like, what questions. Yeah. Absolutely, our malt tissues, 0:21:37.200 --> 0:21:41.040 especially our tonsiles and our pyres patches in our gut, 0:21:42.280 --> 0:21:46.359 they make and secrete a kind of specialized type of 0:21:46.440 --> 0:21:51.119 antibody called IgA, which is different than other antibodies like 0:21:51.160 --> 0:21:54.679 IgM and IgG. And it's probably beyond the scope of 0:21:54.720 --> 0:21:56.840 this episode to get into the nitty gritty on all 0:21:56.880 --> 0:22:00.760 these different types of antibodies, but IgA is a really 0:22:00.800 --> 0:22:04.639 important type of antibody that really does function as a 0:22:04.680 --> 0:22:08.600 first line defense on these mucosal surfaces, and it's being 0:22:08.640 --> 0:22:13.359 secreted from things like our tonsils and adenoids and in 0:22:13.440 --> 0:22:14.960 our guts and things like that. 0:22:15.680 --> 0:22:21.240 This okay, I don't even know where to begin. I'm fascinated. 0:22:21.280 --> 0:22:23.080 I don't even know if I have a question at 0:22:23.080 --> 0:22:26.840 the end of this. I mostly just want to say, how, yes, 0:22:26.920 --> 0:22:29.679 we should definitely do an episode on all the igs. 0:22:30.520 --> 0:22:33.320 And secondly, it's just beautiful. 0:22:34.080 --> 0:22:38.320 It really is. It really is. Wow. Okay. 0:22:38.400 --> 0:22:41.120 No, And so what's the purpose of the crypts? 0:22:42.119 --> 0:22:46.360 They essentially are what are like funneling and shuttling things 0:22:46.960 --> 0:22:51.000 in if that makes sense, and kind of grabbing onto 0:22:51.000 --> 0:22:54.480 them a little bit. It's an increasing surface area for 0:22:54.640 --> 0:23:00.720 stuff to get slooped in. Yeah. Yeah. And our tons 0:23:01.080 --> 0:23:05.679 especially our palatine tonsils and are adenoid or fringial tonsules 0:23:06.080 --> 0:23:10.720 and the other ones as well. They are especially important 0:23:11.119 --> 0:23:15.920 in this role because they form this ring around the 0:23:16.080 --> 0:23:20.560 entrance to two of our most important systems that interact 0:23:20.600 --> 0:23:25.240 with the outside world, our digestive system and our respiratory system. Yeah. 0:23:25.600 --> 0:23:31.000 So our tonsils are being constantly exposed to everything all 0:23:31.119 --> 0:23:33.720 the time. So that's what they do, that's what they're for. 0:23:33.800 --> 0:23:37.600 They are a hugely important part of the development of 0:23:37.640 --> 0:23:43.399 our antibody mediated immune response, especially for things like respiratory 0:23:43.480 --> 0:23:45.760 viruses and bacteria. 0:23:45.960 --> 0:23:47.879 You may have already said this, but which tonsils are 0:23:47.920 --> 0:23:49.000 the biggest. 0:23:49.440 --> 0:23:52.480 Great question. The ones that you think of as tonsils, 0:23:52.520 --> 0:23:55.320 your palatine tonsils, the two that sit in the back 0:23:55.320 --> 0:23:59.440 of your throat are the biggest. Okay, like physically they're 0:23:59.240 --> 0:24:03.280 the big honkers that you see. The tubular tonsils near 0:24:03.400 --> 0:24:08.040 ustation tubes are really quite small. You're adenoid up in 0:24:08.080 --> 0:24:12.159 your nasopharynks can get large and we'll talk about it, 0:24:13.440 --> 0:24:15.920 but is just a single tonsil and is a little 0:24:15.920 --> 0:24:19.520 smaller than the others. And then your lingual tonsils back 0:24:19.600 --> 0:24:22.000 in the back of your tongue are actually a whole 0:24:22.080 --> 0:24:28.919 series of a bunch of really little things, okay, like 0:24:29.040 --> 0:24:32.560 little little cell areas and nuggets. I'm doing things with 0:24:32.640 --> 0:24:35.600 my hands like patcheep, you can't see, yeah, yeah, patt, 0:24:35.960 --> 0:24:36.720 patchy bits. 0:24:36.880 --> 0:24:40.680 Okay, is now the time to say, well, what the heck? 0:24:40.960 --> 0:24:45.040 If they're so like they seem pretty dang cool and important, 0:24:45.240 --> 0:24:49.120 how can we take them out with seemingly few negative 0:24:49.160 --> 0:24:52.560 consequences are their negative consequences? Why do they get so 0:24:52.640 --> 0:24:54.720 bad that they have to be taken out? All of that? 0:24:55.240 --> 0:24:58.240 I know, Yeah, there's a lot of stuff. There was 0:24:58.280 --> 0:24:59.600 a lot where I was like, I don't know where 0:24:59.600 --> 0:25:02.280 to go for We're like, that's what a tonsil is, 0:25:03.000 --> 0:25:08.280 now what So let's start with where can things go wrong? 0:25:08.359 --> 0:25:11.520 If these are something that is so great, then why 0:25:11.560 --> 0:25:15.240 don't we talk about when things are less great? I e. Tonsilitis? 0:25:15.400 --> 0:25:15.840 Shall we? 0:25:16.280 --> 0:25:17.280 Yeah? 0:25:17.520 --> 0:25:22.760 So tonsilitis literally just means inflammation itis in your tonsils. 0:25:23.800 --> 0:25:27.600 And again, at this point, when I'm talking about tonsils, 0:25:27.760 --> 0:25:31.520 I am primarily now only talking about the two big ones, 0:25:31.680 --> 0:25:36.639